Supporting Patients with Nontuberculous Mycobacterial Pulmonary Disease: Ensuring Best Practice in UK Healthcare Settings.

Nontuberculous mycobacterial pulmonary disease (NTM-PD) results from opportunistic lung infections by mycobacteria other than Mycobacterium tuberculosis or Mycobacterium leprae species. Similar to many other countries, the incidence of NTM-PD in the United Kingdom (UK) is on the rise for reasons that are yet to be determined. Despite guidelines established by the American Thoracic Society (ATS), the Infectious Diseases Society of America, and the British Thoracic Society, NTM-PD diagnosis and management remain a significant clinical challenge. In this review article, we comprehensively discuss key challenges in NTM-PD diagnosis and management, focusing on the UK healthcare setting. We also propose countermeasures to overcome these challenges and improve the detection and treatment of patients with NTM-PD.

Axillary lymphadenopathy in a high-risk breast screening patient following the COVID-19 vaccine: a diagnostic conundrum.

A number of COVID-19 vaccines have been approved worldwide to help tackle the pandemic. As with many vaccines, this causes a reactive axillary lymphadenopathy which can mimic potentially metastatic disease in a breast screening patient. It is therefore important to be aware of this side-effect of the vaccination when evaluating the axilla in a breast screening patient. We present a case of biopsy-proven unilateral reactive axillary lymphadenopathy in a high risk BRCA carrier following administration of the Astra Zeneca vaccine.

Co-existent breast malignancy and contralateral primary axillary tuberculosis.

Breast tuberculosis is an extremely rare entity representing less than 0.1% of all breast disease in developed countries. Tuberculous infections within the United Kingdom have seen a steady decline with the highest rates present within North West London where infection rates reach 24.8 per 100,000. The presentation can mimic malignancy and lymphatic involvement of the breast both clinically and mammographically, with nodules within the upper outer quadrant, making accurate diagnosis challenging. Approximately, 30% of breast TB cases present with axillary lymphadenopathy and a recent case series review of approximately 44 cases in London found that the most common presenting feature was a solitary breast lump in 87% of cases.4 We present a case of a patient presenting with primary malignancy and contralateral nodal disease highly suspicious for breast malignancy. Subsequent investigation led to the identification of synchronous localized cancer and tuberculous lymphadenitis. Synchronous presentation is uncommon and recognition and differentiation is vital as axillary lymph node metastasis is the most important factor in the staging of breast carcinoma and determining the subsequent oncological and surgical management.

Diagnosis of non-tuberculous mycobacterial pulmonary disease (NTM-PD): modern challenges.

Non-tuberculous mycobacterial pulmonary disease is growing in incidence and prevalence. However, it is frequently overlooked as a differential diagnosis by both clinicians and radiologists alike due to its non-specific clinical features, wide spectrum of radiological findings and difficulty in isolating the causative organism. The aim of this article is to illustrate the spectrum and follow-up of the radiological findings of non-tuberculous mycobacterial pulmonary disease and the challenges involved in making a diagnosis.

Percutaneous Renal Ablation.

Incidental small renal cell cancers are increasingly being diagnosed on cross-sectional imaging. This review article describes the indications for percutaneous ablation of small renal cell cancers, choice of ablation technologies and imaging follow-up.

Renal Cell Carcinoma: The Evolving Role of Imaging in the 21st Century.

Kidney lesions are commonly an incidental finding on cross sectional studies carried out for a variety of reasons. The detection of renal cell carcinoma (RCC) has increased accordingly. There are a variety of different contrast-enhanced CT imaging protocols that have been developed to help diagnose and stage RCC. More recently, renal MRI and contrast-enhanced ultrasound have also been used as problem-solving tools. This paper describes the epidemiology of RCC and the role of imaging in diagnosis and follow-up.

Current and future management of non-tuberculous mycobacterial pulmonary disease (NTM-PD) in the UK.

A rising number of non-tuberculous mycobacterial (NTM) isolates are being identified in UK clinical practice. There are many uncertainties around the management of non-tuberculous mycobacterial pulmonary disease (NTM-PD), including its epidemiology, diagnosis, treatment and prevention. Regional variations in how patients with NTM-PD are managed reflects the lack of standardised pathways in the UK. Service optimisation and multidisciplinary working can improve the quality of care for patients with NTM-PD, including (1) better identification of patients at risk of NTM-PD and modification of risk factors where applicable; (2) standardisation of reference laboratory testing to offer clinicians access to accurate and prompt information on NTM species and drug sensitivities; (3) development of recognised specialist NTM nursing care; (4) standardisation of NTM-PD imaging strategies for monitoring of treatment and disease progression; (5) establishment of a hub-and-spoke model of care, including clear referral and management pathways, dedicated NTM-PD multidisciplinary teams, and long-term patient follow-up; (6) formation of clinical networks to link experts who manage diseases associated with NTM; (7) enabling patients to access relevant support groups that can provide information and support for their condition; and (8) development of NTM research groups to allow patient participation in clinical trials and to facilitate professional education.

Clinical impact of lifestyle interventions for the prevention of diabetes: an overview of systematic reviews.

OBJECTIVES: To review the clinical outcomes of combined diet and physical activity interventions for populations at high risk of type 2 diabetes. DESIGN: Overview of systematic reviews (search dates April-December 2015). SETTING: Any level of care; no geographical restriction. PARTICIPANTS: Adults at high risk of diabetes (as per measures of glycaemia, risk assessment or presence of risk factors). INTERVENTIONS: Combined diet and physical activity interventions including ≥2 interactions with a healthcare professional, and ≥12 months follow-up. OUTCOME MEASURES: Primary: glycaemia, diabetes incidence. Secondary: behaviour change, measures of adiposity, vascular disease and mortality. RESULTS: 19 recent reviews were identified for inclusion; 5 with AMSTAR scores <8. Most considered only randomised controlled trials (RCTs), and RCTs were the major data source in the remainder. Five trials were included in most reviews. Almost all analyses reported that interventions were associated with net reductions in diabetes incidence, measures of glycaemia and adiposity, at follow-up durations of up to 23 years (typically <6). Small effect sizes and potentially transient effect were reported in some studies, and some reviewers noted that durability of intervention impact was potentially sensitive to duration of intervention and adherence to behaviour change. Behaviour change, vascular disease and mortality outcome data were infrequently reported, and evidence of the impact of intervention on these outcomes was minimal. Evidence for age effect was mixed, and sex and ethnicity effect were little considered. CONCLUSIONS: Relatively long-duration lifestyle interventions can limit or delay progression to diabetes under trial conditions. However, outcomes from more time-limited interventions, and those applied in routine clinical settings, appear more variable, in keeping with the findings of recent pragmatic trials. There is little evidence of intervention impact on vascular outcomes or mortality end points in any context. 'Real-world' implementation of lifestyle interventions for diabetes prevention may be expected to lead to modest outcomes.